Qianda Zou1, Shufa Zheng2, Xiaochen Wang1, Sijia Liu3, Jiaqi Bao1, Fei Yu1, Wei Wu4, Xianjun Wang5, Bo Shen6, Tieli Zhou7, Zhigang Zhao8, Yiping Wang9, Ruchang Chen10, Wei Wang11, Jianbo Ma12, Yongcheng Li13, Xiaoyan Wu14, Weifeng Shen15, Fuyi Xie16, Dhanasekaran Vijaykrishna17, Yu Chen18. 1. Key Laboratory of Clinical in Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, PR China; Center of Clinical Laboratory, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, PR China. 2. Key Laboratory of Clinical in Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, PR China; Center of Clinical Laboratory, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, PR China; State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation center for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, PR China. 3. Key Laboratory of Clinical in Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, PR China; Center of Clinical Laboratory, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, PR China; School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, PR China. 4. State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation center for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, PR China. 5. Department of Laboratory, Affiliated Hangzhou First People's Hospital, College of Medicine, Zhejiang University, Hangzhou, PR China. 6. Department of Clinical Laboratory, Taizhou Hospital of Zhejiang Province, Taizhou Enze Medical Center (Group), Linhai, PR China. 7. Department of Clinical Laboratory, First Affiliated Hospital, Wenzhou Medical University, Wenzhou, PR China. 8. Department of Clinical Laboratory, Lishui Municipal Central Hospital, Lishui, PR China. 9. Department of Clinical Laboratory, Yinzhou People's Hospital, Ningbo, PR China. 10. Medical Examination and Diagnosis Center, Yiwu Center Hospital, Yiwu, PR China. 11. Department of Clinical Laboratory, Lishui People's Hospital, the Sixth Affiliated Hospital of Wenzhou Medical University, Lishui, PR China. 12. Department of Laboratory Medicine, the Affiliated Ningbo No.2 Hospital, College of Medicine, Ningbo University, Ningbo, PR China. 13. Department of Respiratory Diseases, the First People's Hospital of Xiaoshan, Hangzhou, PR China. 14. Department of Laboratory, Second Hospital of Jiaxing, Jiaxing, PR China. 15. Department of Laboratory, First Hospital of Jiaxing, Jiaxing, PR China. 16. Clinical Laboratory, Li Huili Hospital, Ningbo Medical Center, Ningbo, PR China. 17. Department of Microbiology, Biomedicine Discovery Institute, Monash University, Victoria, Australia; World Health Organization Collaborating Centre for Reference and Research on Influenza, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia. 18. Key Laboratory of Clinical in Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, PR China; Center of Clinical Laboratory, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, PR China; State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation center for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, PR China. Electronic address: chenyuzy@zju.edu.cn.
Abstract
OBJECTIVE: The risk factors and the impact of NAI treatments in patients with severe influenza A-associated pneumonia remain unclear. METHODS: A multicenter, retrospective, observational study was conducted in Zhejiang, China during a severe influenza epidemic in August 2017-May 2018. Clinical records of patients (>14 y) hospitalized with laboratory-confirmed influenza A virus infection and who developed severe pneumonia were compared to those with mild-to-moderate pneumonia. Risk factors related to pneumonia severity and effects of NAI treatments (monotherapy and combination of peramivir and oseltamivir) were analyzed. RESULTS: 202 patients with influenza A-associated severe pneumonia were enrolled, of whom 84 (41.6%) had died. Male gender (OR = 1.782; 95% CI: 1.089-2.917; P = 0.022), chronic pulmonary disease (OR = 2.581; 95% CI: 1.447-4.603; P = 0.001) and diabetes mellitus (OR = 2.042; 95% CI: 1.135-3.673; P = 0.017) were risk factors related to influenza A pneumonia severity. In cox proportional hazards model, severe pneumonia patients treated with double dose oseltamivir (300mg/d) had a better survival rate compared to those receiving a single dose (150 mg/d) (HR = 0.475; 95%CI: 0.254-0.887; P = 0.019). However, different doses of peramivir (300 mg/d vs. 600 mg/d) and combination therapy (oseltamivir-peramivir vs. monotherapy) showed no differences in 60-day mortality (P = 0.392 and P = 0.658, respectively). CONCLUSIONS: Patients with male gender, chronic pulmonary disease, or diabetes mellitus were at high risk of developing severe pneumonia after influenza A infection. Double dose oseltamivir might be considered in treating influenza A-associated severe pneumonia.
OBJECTIVE: The risk factors and the impact of NAI treatments in patients with severe influenza A-associated pneumonia remain unclear. METHODS: A multicenter, retrospective, observational study was conducted in Zhejiang, China during a severe influenza epidemic in August 2017-May 2018. Clinical records of patients (>14 y) hospitalized with laboratory-confirmed influenza A virus infection and who developed severe pneumonia were compared to those with mild-to-moderate pneumonia. Risk factors related to pneumonia severity and effects of NAI treatments (monotherapy and combination of peramivir and oseltamivir) were analyzed. RESULTS: 202 patients with influenza A-associated severe pneumonia were enrolled, of whom 84 (41.6%) had died. Male gender (OR = 1.782; 95% CI: 1.089-2.917; P = 0.022), chronic pulmonary disease (OR = 2.581; 95% CI: 1.447-4.603; P = 0.001) and diabetes mellitus (OR = 2.042; 95% CI: 1.135-3.673; P = 0.017) were risk factors related to influenza A pneumonia severity. In cox proportional hazards model, severe pneumoniapatients treated with double dose oseltamivir (300mg/d) had a better survival rate compared to those receiving a single dose (150 mg/d) (HR = 0.475; 95%CI: 0.254-0.887; P = 0.019). However, different doses of peramivir (300 mg/d vs. 600 mg/d) and combination therapy (oseltamivir-peramivir vs. monotherapy) showed no differences in 60-day mortality (P = 0.392 and P = 0.658, respectively). CONCLUSIONS:Patients with male gender, chronic pulmonary disease, or diabetes mellitus were at high risk of developing severe pneumonia after influenza A infection. Double dose oseltamivir might be considered in treating influenza A-associated severe pneumonia.
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